"T" is for "Trans"....and for BIID too?

I don't know about you, but I watched with laser-beam intensity when Bruce Jenner was interviewed by Diane Sawyer earlier this summer.  At 65 years old, Jenner announced to the world that he was a "woman in my soul" and had been for a long long time.  Announcing to Sawyer and the rest of us that he made the decision to fully transition from male to female, Sawyer asked him a series of questions about his status.  What she didn't ask him about was BIID (Body Integrity Identity Disorder). 

Now that "I am Cait" has aired (Jenner's reality series on cable), it is clear (to me at least!) that Jenner is currently a biological man from the waist down...while presenting herself as woman from the waist up.  If ever there was a time to introduce us all to BIID, I believe this is it.  As I have found, of the approximately 700,000 transgendered individuals in this country today, a very small percentage actually go forward and have the surgery to alter their genitals.  This from a study out of Columbia University focused on the transgender community.  Besides the intense pain associated with post-surgery recovery....lack of sensation associated with so-called "successful" surgical outcomes...and the visual reality of "This is what it looks like now?!"...it's no wonder that one doesn't choose to have the final surgery in order to be legitimately recognized in this country as a trans male or female.  This also has helped me to understand why the violent assault rate, suicide rate, and murder rate is elevated among members of the transgender community generally speaking.  (If one is going to present themselves as fully female or fully male...one has to be HONEST about that before their first "kiss" with an otherwise self-proclaimed heterosexual male or female!)   Ask Jerry Springer.  He has talked about this often enough on his show over recent years! 

As friends and I have discussed, we can't figure out how Cait Jenner is going to turn out in this regard.  She has stated that she was and has been always attraced to women---but in one of her recent episodes of "I am Cait", she claims she doesn't know what gender she'd date now.  All I know is that if she's still male below the belt, it won't be pretty if her chosen female love interest is also male below the belt!  Unless she chooses gender fluidity...which is a whole other issue for another blog post.

As one of the disorders suggested for review and consideration in the current DSM-5, BIID syndrome was described as far back as the early 19th century in the book "From Paralysis to Fatigue A History of Psychosomatic Illness in the Modern Era" by Edward Shorter.  To make a long story short, a woman REALLY wanted a portion of her leg amputated in spite of no evidence to suggest she needed it (this was back in 1818).  Her anxiety and suffering became so great, that "two surgeons of eminence in the country yielding to her entreaties, performed the operation.  On completion of the amputation they were surprised to see that they had removed a normal joint."

Unlike people who suffer from BDD (Body Dysmorphic Disorder), which is recognized as a diagnosable psychiatric condition, people with BIID do NOT want to be rid of their body parts because they perceive them to be hideous, diseased, or faulty in any way.  Rather, the body parts feel alien, as if they don't belong.  In spite of their intact bodies, BIID patients do not feel whole. 

In her recent book, "Falling Into the Fire", author Christine Montross, herself a psychiatrist and lesbian, discusses her own encounters with BIID patients.  "The way in which personal identity seems inextricably linked to the desire for amputation has led to comparisons between BIID and gender dysphoria", states Montross.  "In gender dysphoria (previously classified psychiatrically as gender identity disorder and in lay terminology as transsexxualism), people experience their gender as different from the one that their physical sex characteristics typically indicate."  As Montross continues in her book, "These syndromes share a disconnect between the fundamental way in which a person feels his identity ought to be and the way that his body is." 

Montross cites several studies in her book regarding BIID;  one is an Amsterdam study where 54 individuals with BIID were administered a questionnaire.  "Actual amputation of the limb was effective in all 7 cases who had surgical treatment." study administrator Rianne Blom writes.  "Amputation of the healthy body part appears to result in remission of BIID and an impressive improvement of quality of life."  One responder to the questionnaire revealed as much when he or she wrote, "I'm wondering if I am eligible to participate in this study, because since my amputation I do not have BIID feelings anymore."

"How then, as doctors, do we proceed?", asks Montross in her book.  "A surgical procedure exists that appears to alleviate the anguish of people who are truly suffering.  In attempts to treat the condition, medications have proved ineffective, and psychotherapy, as the British psychiatrist Russell Reid as put it, "doesn't make a scrap of difference in these people"  At present no treatment exists that we know of that is anywhere near as helpful as the surgery."  But what surgery are we talking about here folks?  You can shave an adam's apple, create and/or remove breasts, narrow the jawline, and removed unwanted face and body hair.  But can we really shrink (or increase?) the size of one's hands.....surgically "lighten up" or deepen one's voice...or create genitals that look and feel like the real thing?  No, we can't.  Acceptance is the key.  Of oneself...and of others.  Just be and remain honest;  that is all we really needed in the first place...

Montross' book, to say the least, is beyond fascinating regarding her own experiences as a clinician treating BIID as well as the existing research concerning it.  "Falling Into the Fire:  A Psychiatrist's encounters with the Mind in Crisis" by Christine Montross.






    

Name 20 Things You See.....

As I have shared before in this blog, a person's general mental health and well being is best measured by his (or her) ability to live in the present.  It sounds easy enough, but when you think about it, it's not so easy to do when our past---or the future---keeps holding us captive. 

"Jane" (not her real name) was a victim of both infidelity and homicide.  She had no idea that her husband was having an affair with one of his employees.  With several children and another on the way, Jane found out from the police that her husband was cheating.  This is because Jane's husbad was shot dead in a local area parking lot by his lover's jealous husband.  From that moment on, Jane became stuck in the horror, terror, and confusion of  "What's going to happen to me and my children!?"

"Phil" loved to play baseball.  Phil's parents loved the idea of Phil having a career in baseball.  Phil's paternal grandfather was a Houston Astros pitcher back in the late 60s and early 70s.  Phil's father had often recalled all the "perks" that accompanied his own father's career on and off the field.  The parties...the adoring fans...and the star treatment;  Phil was a natural-born successor to his granddad's throne.  Even today, all these years later, Phil will often daydream at his desk about the career that could have been.  It never happened for Phil, but with his young wife now pregnant...who knows?

"Sandra" was just about to graduate from college and found herself in a major twist about the future.  "I want to get out of Michigan...but I don't even have any job interviews lined up yet!", she lamented.  Sandra was finding it more and more difficult to fall asleep at night, and when she finally did, she'd wake up at 3 or 4AM like clockwork.  Sanda began to lose weight and her energy level was dwindling fast.  "Why did I even bother to get a degree if it's all led to this?" asked Sandra...

Whatever the circumstances are we experience in life, it IS extremely easy to get caught up in what comes at us from behind (the past)...or what we perceive as being up ahead (the future).  So often, we don't realize how much time and energy we spend on thoughts, feelings, and intentions that have to do with "back then"...or "up ahead".  Why do we do it?  As silly as it may seem or sound, focusing on "somewhere else" in time does serve as a major distraction to present-day reality.  Even when that somewhere else comes from memories that are 5, 10, or 50 years old.  Even when that somewhere else comes from worries, fantasies, and/or anxiety-based fictions that haven't even happened "yet"....and (more importantly!) may NEVER happen!

So many times, we avoid present reality because we literally don't want to experience the changes that go along with it.  As someone once said, "Very easy to grow old;  not so easy to grow up!"  I was just talking to someone earlier today who said her ex husband had called out of the blue to argue about the cheating allegations which broke up their marriage.  They have been divorced ten years;  her husband was literally caught back then with his pants down.  It may not initially appear that this is an incidence of avoiding present reality---but it was.  Thinking about it, what's is anybody's point in bringing something up that happened over 10 years ago as if it is a "right now" and "real life" present day problem?  It's not.  Except within the mind of this particular ex husband as it was today.  All he was doing by calling his ex wife out of the blue was inviting her to "play" this twisted game of "Let's go back and time and pretend we're still married..."  No thanks.  Roger and out.  It's over.  Been over for ten years as a matter of fact.  Time to get real.

Drifting backwards or forwards in time serves no useful purpose unless it serves to teach us lessons we can apply in the present by virtue of our present behaviors.  Otherwise, we are going to depress ourselves...scare ourselves silly....believe our own narcissistic-based fantasies about ourselves (and others!)---or hate ourselves more than we do "right now".

So, how do we move away from getting stuck in our past...or in a future that hasn't happened?  One exercise is "Name 20 Things You See".  You can do this when you find yourself getting caught up mentally in a whole lot of thoughts, fears, suspicions, and other uncomfortable feelings.  Whether you are at work, in bed, at home, out somewhere....just name 20 things you see.  By forcing yourself to think rationally in this way, "There's a picture on the wall of a man in a boat....there's my dog...there's Big Brother on the t.v......there's my 1/2 bottle glass of pinot grigio on the nightstand next to me..." we are literally taking ourselves mentally into our own present moment. 

There are other similar exercises we can pursue to practice living in the present while at the same time successfully managing our own current problems, opportunities, and issues in a real-life right now kind of way.  Remember, nothing can be done about things that haven't happened yet...or happened a long time ago.  But, right now, today, we can work to either solve...resolve...or dissolve whatever issues, opportunities, or problems that are happening to us right now and in real time.

(In case you missed it, the 1/2 bottle glass of pinot grigio on the nightstand...that present reality DOES indeed represent a real-life right now problem if that wine keeps showing itself on that nightstand on any kind of regular or semi-regular basis!)

The past is history...the future is a mystery...and the present is of course a gift;  that's why we call it "the present" in the first place!  Naming 20 things we see today, 20 things we are grateful for today, 20 things we can't stop thinking about....this can represent the beginning of our way "out" (of the past and/or the future) and our re-entry into our lives, as we are living them, right now!

Have a great week!








 


 

When People Are Dismissive....

Have you ever been at a social event hosted, by let's say, your sister?  As you enter the house, you see her speaking to someone you don't know.  As you approach your sister to say hi and let her know you are here, your sister waves you off so as to continue her conversation with the person you do not know.  What's wrong with this picture?  Or how about being over someone's home for dinner, and your host doesn't introduce anyone to each other?   Better yet, if there are introductions, they go something like this:  "Oh, this is my hairdresser!"  "Oh, this is my yoga teacher!  He's great!"  "Oh, this is my dog groomer;  she's just fabulous with long hairs!"  Really?  It is amazing how insensitive and inconsiderate we can be when it comes to the ways in which we treat each other in social situations.  Being dismissive comes in a variety of forms, but when all is said and done...it leaves the person being dismissed feeling not so hot.

 

When people are dismissive to us, we feel (first and foremost) like we don't matter.  Like something or someone else just popped up or showed up to immediately take your place.  Yet we keep doing it to each other like it is our job in so many social situations.  Why is that?  Today's blog post attempts to unravel the mystery behind the history of dismissive behavior towards others....

 

1.  People with undiagnosed and untreated ADHD (that would be Attention Deficit Disorder) are notorious dismissers by their very nature.  The older they are without having recieved a proper diagnosis or appropriate treatment...the worse they are going to be in this area of functioning.  Dismissive behavior only begins to describe the pattern of behaviors common among ADHDers without a clue:  they interrupt people often and without hesitation...they loudly proclaim their "orders" for what should happen next (yes, especially in social situations!)...they are easily frustrated and show it (through their tears and/or their rants and/or their meltdowns)...AND they tend to change topics mid-sentence like they just discovered the cure for cancer and shouldn't we re-focus our attention(s) now on whatever gold is about to proceedeth out their mouth!

 

Yes, ADHDers who remain untreated for their condition can be the most annoying, disrespectful, and self-involved people you will ever know.  On the other hand, they do what they do because, in their own mind, they are in a constant state of emergency in just trying to ensure their own needs-satisfaction.  Yes, that's right:  they do what they do to make sure they get what they think they need RIGHT NOW!

My most recent encounter with an undiagnosed and untreated ADHDer was when I was at a social event, sat down, and was immediately told "YOU CAN'T SIT THERE!" because...???  Because my ADHDer lives in a state of constant emergency and need to be in control---so my seating choice didn't jive with who and where I was "allowed" to sit (in her mind of course!). 

 

I think of another ADHDer who, many years ago, asked me over for breakfast because I was missed so much and "You're my best friend.." blah blah.  Before I could hang up, this ADHDer had enough where-with-all to then add:   "Oh, I don't have any stuff for breakfast here!  Can you bring the toast and the butter and some coffee and a couple eggs...?"  How about "NO!" and we meet at a local restaurant?  But you see, in the ADHDers undiagnosed and untreated mind...whatever they think of when they think it is "the answer" or "the solution" or "the best way" (for them of course!).

 

Don't get me wrong.  I'm an ADHDer too.  Yet I received treatment (Thank You Lord!) many years ago and allowed that treatment to change me and my life for the much better.  I can remember being told to "Stop Interrupting! about every hour on the hour as a little kid.  Grant it, my household may have been filled with adult ADHDers...but it all felt a bit more socipathic to me!  ;-)  And now I wonder why I'm funny as hell (as in hilarious funny) and could work a room of 1,000 without a bead of sweat or an ounce of anxiety attached.  It all started in my aunt and uncle's living room with my parents present...and little ol' me.

 

Beyond ADHD, people with undiagnosed and untreated Cluster B personality disorders (Narcissistic, Histrionic, Borderline, and Anti-Social) as well as others who have long-standing but untreated mood or anxiety-based disorders have extreme difficulty viewing others as "equals".  This view is then demonstrated through a profound and ongoing lack of social graces.  Again, if you can think of someone who is basically on fire emotionally 2/47...and is looking for the "right" fireman (or firewoman!) to put it out for them...then you'll have a good idea of why these folks are so good at being dismissive and/or otherwise "rude" to the people they know...while being over-solicitious to the people they don't know.  Bottom like is that if these folks had just one sentence to convey to the world around them...and especially to those they are just meeting for the first time or getting to know...it would be this:  "Are you going to help me RIGHT NOW?!"

 

Until next time....